What is a urethrostomy?
A urethrostomy is a surgical procedure to create an opening in the urethra, the tube through which urine flows from the bladder and is voided. The surgery is performed to correct a urethral obstruction, which can be caused by protein plugs, stones, trauma, or scarring (stricture). A urethral obstruction is a serious, life-threatening condition; therefore, urethtrostomies are often performed on an emergency basis. In male cats, a perineal urethrostomy, or PU, is performed, and in dogs a scrotal urethrostomy is performed.
What are the indications for performing a urethrostomy?
A urethrostomy is indicated when the urethral opening is persistently obstructed or is too narrow. It is most commonly performed on male cats that suffer from feline urologic syndrome, a condition that makes them prone to protein plugs, bladder “sand” or “sludge,” or bladder stones that enter the urethra and obstruct the flow of urine. Some cats with this condition will respond to medication and/or a special diet, but surgery is the best treatment for those who have recurrent episodes of obstruction. In dogs, a urethrostomy is indicated when bladder stones have traveled to the urethra and caused a partial or complete obstruction to the flow of urine. The breeds most commonly affected by this condition are Dalmatians and Lhasa Apsos. In both cats and dogs, a urethrostomy would be performed in cases of severe penile trauma or scarring/stricture that does not allow for the normal passage of urine.
What is the difference between perineal and scrotal urethrostomy?
The difference between these two procedures is where the opening in the urethra is made. A perineal urethrostomy creates an opening in the perineum, or the space between the rectum and scrotum. The penis is completely excised and the urethral opening is made larger to allow urine, stones, and sand to pass. A scrotal urethrostomy creates an opening directly in front of the scrotum (intact males must be castrated at the same time). The penis is left intact, and most often the dogs will continue to exhibit the same voiding behavior, such as lifting their leg, even though the urine is voided from a different area.
What is the post-operative care?
Patients that have had a urethrostomy must be kept calm and inactive during their recovery. Often times, they will bleed from the surgical site for up to 10 days post operatively. Keeping them calm may help in reducing the amount of bleeding. Cats should have constant access to a litter box, as they will feel an increased urgency to urinate. The litter should be dust/clay free; for example, there are several brands of litter that make pellets from old newspaper. Dogs may also feel an increased urgency to urinate and be walked more often. Any patient that has had a urethrostomy performed must wear an Elizabethan collar at all times until suture removal.
What are the risks and complications?
The overall risk involved for a healthy patient is low. The risk can be increased by compromised renal function compounded by general anesthesia. Other risks are hemorrhage, post-operative infection, and wound dehiscence (breakdown). Scar formation can occur in some cats, causing a stricture of the urethra, which requires additional surgery.